Juliana Lustosa Torres

Inspiratory Muscular Training in Chronic Stroke Survivors: A Randomized Controlled Trial

OBJECTIVE To assess the effectiveness of inspiratory muscular training (IMT) on measures of strength, resistance, functional performance, and quality of life (QOL) for chronic stroke survivors. DESIGN Double-blinded randomized controlled trial. SETTING Research laboratory. PARTICIPANTS Subjects (N=21) with stroke (11 men, 10 women; maximal inspiratory pressure [MIP] <90% of predicted values) were randomly assigned to the experimental (n=11) and control groups (n=10); 18 participants completed all testing and training. INTERVENTIONS Interventions were based on home-based training, with resistance adjusted biweekly to 30% of MIP for the experimental group. The control group underwent the same protocol without the threshold resistance valve. Both groups received home training 30 minutes a day 5 times a week for 8 weeks. MAIN OUTCOME MEASURES MIP, inspiratory muscular endurance (IME), functional performance, and QOL. RESULTS There were significant between-group differences for the MIP and IME measures. Significant changes were observed for only the experimental group for MIP (67.8±14.6 at baseline to 102.2±26.0cmH(2)O at posttraining) and IME (31.8±19.3 to 49.2±21.1cmH(2)O). No statistically significant differences were observed for measures of functional performance and QOL. CONCLUSIONS Significant short-term effects of the IMT program for inspiratory strength and endurance were observed in chronic stroke survivors. These findings gave some indications that IMT may benefit people with stroke, and it is feasible to be included in rehabilitation interventions with this population.

Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study

BACKGROUND Frailty and sarcopenia are frequent conditions in the elderly and are related to inactivity and functionality. However, little is known about the influence of the sarcopenia indicators on the frailty profile or their functional implications. OBJECTIVE To evaluate whether the indirect indicators of sarcopenia and functionality influence the frailty profile in elderly subjects. METHOD This was a cross-sectional study with 53 elderly subjects recruited by an active search in a secondary health care service. The indirect indicators of sarcopenia were body mass index (BMI), gait speed, Mini-Nutritional Assessment (MNA), Human Activity Profile (HAP), and handgrip strength. Frailty was characterized according to Frieds Frailty Phenotype. Functional capacity was assessed according to the Short Physical Performance Battery (SPPB). Physical activity level was assessed by HAP. Data were analyzed by analysis of variance (ANOVA) and multiple regression. RESULTS Overall, 75.5% of the subjects were women, with a mean age of 76.72 (±5.89) years; 15.1% were frail and 54.7% pre-frail; and the level of physical activity was the most prevalent indicator of sarcopenia. Significant differences (p<0.05) were observed in both the physical activity level and gait speed between the non-frail and pre-frail groups and between the non-frail and frail groups. In addition, some sarcopenia indicators were associated with functional capacity and geriatric depression score. CONCLUSION The level of physical activity and gait speed appeared to be the most relevant factors in the development of frailty in the study sample, which may have functional implications.

Functional performance and social relations among the elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil: a population-based epidemiological study

This study was conducted in a probabilistic sam- ple of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.Este trabalho foi conduzido em uma amostra probabilistica de 2.055 idosos da Regiao Metropolitana de Belo Horizonte, Minas Gerais, Brasil, com o objetivo de examinar componentes da rede social (situacao conjugal, visita de filhos, outros parentes e amigos) e do apoio social (satisfacao com as relacoes pessoais e existencia de pessoas com quem contar) associados a limitacao para realizar atividades basicas da vida diaria(ABVDs). A analise multivariada foi baseada no modelo Hurdle. A performance na realizacao de ABVDs apresentou associacoes independentes e significantes com a rede social (menos encontros com amigos e nao possuir filhos) e o apoio social (insatisfacao/indiferenca com as relacoes pessoais). Essas associacoes persistiram apos ajustamentos por caracteristicas sociodemograficas, condicao de saude e outros indicadores das relacoes sociais. Nossos resultados reforcam a necessidade de maior atencao para a rede social e apoio social aos idosos com limitacoes funcionais, e para idosos com redes sociais e apoio social frageis.

Nutritional Risk is Associated with Chronic Musculoskeletal Pain in Community-dwelling Older Persons: The PAINEL Study

ABSTRACT Malnutrition is a risk factor for noncommunicable diseases related to ageing, and it can also contribute to musculoskeletal health. This study investigated whether nutritional risk is associated with chronic musculoskeletal pain in community-dwelling older persons. Nutritional risk was assessed by the DETERMINE Checklist. Chronic musculoskeletal pain was defined as the presence of pain in the past six months that did not disappear for at least 30 consecutive days. Multivariate logistic regression including confounding variables was used for the analysis. The sample was comprised of 383 participants (age 75.6 ± SD 6.1); the majority were at moderate-to-high nutritional risk (69%) and approximately one third presented chronic musculoskeletal pain (30%). The nutritional risk score was independently associated with chronic musculoskeletal pain: adding one unit in the risk score produces an 11% increment in the odds of presenting pain (OR 1.109, 95% CI 1.022–1.204). Individuals classified into moderate- or high-risk categories also had substantially higher odds (∼90%) of presenting chronic musculoskeletal pain when compared to those in the low-risk category, although our findings were only marginally significant. This is the first study to demonstrate the association between nutritional risk and chronic musculoskeletal pain above and beyond the contributed effects from relevant confounders.

Wealth and Disability in Later Life: The English Longitudinal Study of Ageing (ELSA)

We examined wealth inequalities in disability, taking into account the effect of both depression and social support among older English adults using data from 5,506 community-dwelling people aged 50 years and over from the English Longitudinal Study of Ageing (ELSA). Disability was measured as self-reported limitations in the Basic Activities of Daily Living (ADL) and Instrumental Activities of Daily Living (IADL). Depressive symptomatology was measured using the 8-item Center for Epidemiological Studies-Depression (CES-D) scale. Social support was assessed by marital status and frequency of contact with friends, relatives or children. Multinomial logistic regression models were used to assess the role of social support and depressive symptoms on disability by total household wealth, which is a measure of accumulated assets over the course of life. Our findings showed that the poorest men with disability were more likely to live without a partner and have no weekly contact with children, family or friends compared to the wealthiest. Among women with disability, the poorest were more likely to report loneliness and have no partner while the wealthiest and the intermediate groups were more likely to be living with a partner. There was a strong inverse dose-response association between wealth and depressive symptoms among all participants with disability. This study shows a clear wealth gradient in disability among older English adults, especially for those with elevated depressive symptoms.

Funcionalidad y relaciones sociales de ancianos en el área metropolitana de Belo Horizonte, Minas Gerais, Brasil: un estudio de base poblacional

This study was conducted in a probabilistic sam- ple of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.Este trabalho foi conduzido em uma amostra probabilistica de 2.055 idosos da Regiao Metropolitana de Belo Horizonte, Minas Gerais, Brasil, com o objetivo de examinar componentes da rede social (situacao conjugal, visita de filhos, outros parentes e amigos) e do apoio social (satisfacao com as relacoes pessoais e existencia de pessoas com quem contar) associados a limitacao para realizar atividades basicas da vida diaria(ABVDs). A analise multivariada foi baseada no modelo Hurdle. A performance na realizacao de ABVDs apresentou associacoes independentes e significantes com a rede social (menos encontros com amigos e nao possuir filhos) e o apoio social (insatisfacao/indiferenca com as relacoes pessoais). Essas associacoes persistiram apos ajustamentos por caracteristicas sociodemograficas, condicao de saude e outros indicadores das relacoes sociais. Nossos resultados reforcam a necessidade de maior atencao para a rede social e apoio social aos idosos com limitacoes funcionais, e para idosos com redes sociais e apoio social frageis.

Funcionalidade e relações sociais entre idosos da Região Metropolitana de Belo Horizonte, Minas Gerais, Brasil: um estudo epidemiológico de base populacional

This study was conducted in a probabilistic sam- ple of 2,055 elderly in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil, to examine components of social network (conjugal status and visits by the children, other relatives, and friends) and social support (satisfaction with personal relations and having persons on whom to rely) associated with limitations in performing basic activities of daily living (ADL). Multivariate analysis used the Hurdle model. Performance of ADL showed independent and statistically significant associations with social network (fewer meetings with friends and not having children) and personal support (dissatisfaction/indifference towards personal relations). These associations remained after adjusting for social and demographic characteristics, health status, and other indicators of social relations. Our results emphasize the need for greater attention to social network and social support for elderly with functional limitations and those with weak social networks and social support.Este trabalho foi conduzido em uma amostra probabilistica de 2.055 idosos da Regiao Metropolitana de Belo Horizonte, Minas Gerais, Brasil, com o objetivo de examinar componentes da rede social (situacao conjugal, visita de filhos, outros parentes e amigos) e do apoio social (satisfacao com as relacoes pessoais e existencia de pessoas com quem contar) associados a limitacao para realizar atividades basicas da vida diaria(ABVDs). A analise multivariada foi baseada no modelo Hurdle. A performance na realizacao de ABVDs apresentou associacoes independentes e significantes com a rede social (menos encontros com amigos e nao possuir filhos) e o apoio social (insatisfacao/indiferenca com as relacoes pessoais). Essas associacoes persistiram apos ajustamentos por caracteristicas sociodemograficas, condicao de saude e outros indicadores das relacoes sociais. Nossos resultados reforcam a necessidade de maior atencao para a rede social e apoio social aos idosos com limitacoes funcionais, e para idosos com redes sociais e apoio social frageis.